Should You Have a Do - Not Resuscitate Order? What You Should Know

A DNR, or Do Not Resuscitate, order is a directive that tells doctors and other medical staff that, in the event of a cardiac arrest or other serious medical incident, you do not wish to receive lifesaving care—such as CPR, defibrillation, medication, or artificial breathing.

It might be difficult for some to understand why anyone would want to get a DNR. Yet, according to an article in The Times, doctors themselves are more likely to have DNR orders than those outside of the medical profession. They realize what many people do not—that, especially for people who are elderly, sick, or frail, lifesaving care can be painful and debilitating in itself. Sometimes it leads to brain damage and other serious health complications, and it does not have a high survival rate.

The reality is that if you suffer cardiac arrest in a hospital and undergo CPR, your chances are mixed. While the rates of survival are up from the 2000’s according to a recent study in the New England Journal of Medicine, it’s still just around 18-20% for older patients--not exactly high odds. And if you do survive, you have a 58% chance of being alive a year later—and a 48% chance that you will have suffered little or no brain damage.

Depending on how you look at it, those are either better odds than before—or still fairly grim odds. The reality remains that if you undergo CPR after a cardiac arrest, you take your chances that you’ll survive—or that you won’t have serious brain damage afterwards.

If you do undergo extreme lifesaving measures, it can be painful and traumatizing. CPR can be physically traumatic, especially for more fragile older adults—broken ribs are not an unusual result of chest compressions, and older people’s bones tend to be more rigid and brittle than those of younger patients. Resuscitation can also involve a defibrillator shock or a tube going down your throat to help you breathe—measures that can be quite painful and, in more fragile adults, sometimes cause other injuries.

However, your chances of surviving a cardiac arrest are higher with than without CPR and other lifesaving measures—even if the results are not optimal. Here are a few things to keep in mind when deciding if a DNR is right for you.

There are sometimes loopholes

State rules vary regarding how people treat your DNR order, and they usually aren’t iron-clad. For instance, in most states, if you experience cardiac arrest outside of a hospital, a bystander can step in and deliver CPR despite your DNR wishes, and not face legal repercussions as long as they are following their training and acting in your best interests according to the state’s Good Samaritan Law.

Generally it’s only medical staff who are required to follow DNR orders. But even that can be tricky. For instance, Washington State recently gave word to medical staff who work in nursing homes that they might not, in all situations, be immune to legal charges if they withhold lifesaving care as per the patient’s DNR order. In Ohio, there are two types of DNR orders determining the level of care you want in case of a cardiac arrest, and does not mean “do not treat.”

Know your facility’s policies

Depending on where you are when you suffer a cardiac arrest, the staff in your nursing home or assisted living facility may or may not honor your DNR directive. Often, nursing home policies might seem clear on this—but the reality on the ground is a little less clear-cut, and employees who refuse lifesaving care can face penalties even if they are following nursing home policy.

For example, recently an 87-year-old woman in California with a DNR order was denied CPR. The nursing home where she lived initially stood behind the nurse on duty, saying that she followed protocol; it later retracted that and announced it was conducting an investigation into the situation, even though the family was not pressing charges. Cases like this could have a chilling effect on nursing home policy and the willingness of staff to withhold care.

If you or a loved one has a DNR and is considering moving to a nursing home or assisted living facility, it can be a good idea to ask whether nursing staff has had to make decisions regarding delivery of lifesaving care for a resident with a DNR before—and how it was handled.

Know your own health situation

Your chances for a good outcome go down if you are already infirm or fragile, or suffer from an illness. Most people who have DNR orders are the very elderly and those suffering from terminal or otherwise debilitating disease. In these cases, many doctors believe that CPR—which can be a fairly physical procedure that can cause injuries, even in healthy people—can be needlessly cruel.

Be sure your family is on the same page

If you have a DNR order, you will most likely need to have a talk with loved ones. You may not be able to talk or communicate in the moment when you might need lifesaving care—and there’s a high chance you won’t be able to advocate for yourself—and you may need someone to explain that you do not wish to receive lifesaving care.

Choosing whether to have a Do Not Resuscitate order can be difficult. Making decisions about end-of-life care is never easy, and sometimes requires having difficult conversations with your loved ones as well as your doctor. However, it’s important to think this through while you’re still able to make a decision for yourself. Consider your state of health, the policies at the nursing home or assisted facility where you live (if applicable), and the state law governing types of DNR orders. Hopefully, once you have a better idea of what your options are, you will be able to make a decision that will lead to better end-of-life care.

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About the author

Dr. Mary Williams, RN, DC

Dr. Mary Williams, R.N., D.C is a Doctor of Chiropractic with an extensive background as a Registered Nurse and experienced Core Instructor for the American Heart Association. She has over 30 years of hands-on medical and instructional experience.